Abstract
Purpose: Patient-specific, flanged acetabular components are used for the treatment of Paprosky type III defects during revision total hip arthroplasty (THA). This monocentric retrospective cohort study analyzes the outcome of patients treated with custom made monoflanged acetabular components (CMACs) with intra- and extramedullary iliac fixation. Methods: 14 patients were included who underwent revision THA with CMACs for the treatment of Paprosky type III defects. Mechanism of THA failure was infection in 4 and aseptic loosening in 10 patients. Seven patients underwent no previous revision, the other seven patients underwent three or more previous revisions. Results: At a mean follow-up of 35.4 months (14–94), the revision rate of the implant was 28.3%. Additionally, one perioperative dislocation and one superficial wound infection occurred. At one year postoperatively, we found a significant improvement of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (p = 0.015). Postoperative radiographic analysis revealed good hip joint reconstruction with a mean leg length discrepancy of 3 mm (−8–20), a mean lateralization of the horizontal hip center of rotation of 8 mm (−8–35), and a mean proximalization of the vertical hip center of rotation of 6 mm (13–26). Radiolucency lines were present in 30%. Conclusion: CMACs can be considered an option for the treatment of acetabular bone loss in revision THA. Iliac intra- and extramedullary fixation allows soft tissue-adjusted hip joint reconstruction and improves hip function. However, failure rates are high, with periprosthetic infection being the main threat to successful outcome.
Highlights
The revision burden after total hip arthroplasty (THA) will increase [1]
Based on computed tomography (CT), custom made acetabular components offer the surgeon the option to add metal sockets to the implant volume according to the defect of the hemipelvis, to adjust flanges for fixation devices to the remaining bone stock, and to plan the reconstruction of the hip center of rotation (COR) [9]
To the best of our knowledge, the current study reports the largest cohort study of patients treated for acetabular bone loss after revision THA (rTHA) failure with one special custom made monoflanged acetabular components (CMACs) design
Summary
The revision burden after total hip arthroplasty (THA) will increase [1]. Acetabular bone loss is a major surgical challenge in revision THA (rTHA), in re-revisions or after implant migration. Modular, highly porous acetabular revision systems with and without metal wedges, buttress augments, and cage options [6,7]. It has not yet been defined which strategy should be considered as the benchmark [8]. Based on computed tomography (CT), custom made acetabular components offer the surgeon the option to add metal sockets to the implant volume according to the defect of the hemipelvis, to adjust flanges for fixation devices to the remaining bone stock, and to plan the reconstruction of the hip center of rotation (COR) [9]
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